McCoy v. Metropolitan Life Insurance

861 F. Supp. 40, 1994 U.S. Dist. LEXIS 12258, 1994 WL 456616
CourtDistrict Court, E.D. Michigan
DecidedAugust 23, 1994
DocketCiv. A. 93-73811
StatusPublished
Cited by2 cases

This text of 861 F. Supp. 40 (McCoy v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McCoy v. Metropolitan Life Insurance, 861 F. Supp. 40, 1994 U.S. Dist. LEXIS 12258, 1994 WL 456616 (E.D. Mich. 1994).

Opinion

ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

GADOLA, District Judge.

Defendant filed the instant motion for summary judgment May 9, 1984. Plaintiff filed a response May 20, 1994. Defendant filed a reply June 7, 1994.

I. Facts

Plaintiff Leonard McCoy was an hourly worker with General Motors (“GM”) Truck and Bus Division in Pontiac, Michigan beginning in August 1977. Plaintiffs position with *41 GM was as an electrical trouble shooter/assembler.

Pursuant to a collective bargaining agreement with the International Union, United Automobile, Aerospace and Agriculture Implement Workers of America (the “Union”), of which plaintiff is a member, GM agreed to provide certain benefits, including disability-benefits. Under the GM’s disability benefits contract with the Union, entitled “The General Motors Life and Disability Benefits Program for Hourly Employes” [sic], the insurance carrier, 1 that is, defendant MetLife

may require an applicant, as a condition of eligibility, to submit to examinations by a physician designated by it for the purpose of determining his eligibility.

Art. II, § 7(e), Ex. B to Defendant’s Motion at 32. Under a Supplemental Agreement to the disability plan, GM and the Union agreed to participate in a so-called “GM-UAW Impartial Medical Opinion Program” (“IMO Program”). The IMO Program requires that

[examinations requested by the insurance company in accordance with Article II, Section 7(e) of the Program shall be performed, whenever possible, by physicians who have been designated as impartial medical examiners in accordance with agreements made between the Corporation and the Union____ The opinion of such an examiner with respect to the existence of total disability as defined in Article II, Section 7(a) of the Program shall be final and binding upon the Corporation, the Union, the insurance company, and the employe [sic].

Ex. A to Defendant’s Motion at 12.

In 1985, plaintiff was diagnosed as suffering from carpal tunnel syndrome. To correct that condition, plaintiff underwent surgery to his right hand. In 1988, plaintiff underwent a second surgery, this time to his left hand. Both surgeries were performed by plaintiffs physician, Dr. Winkelman.

Plaintiffs condition and consequent 1988 surgery left him unable to perform his regular duties at GM. In June 1988, plaintiff applied for and began receiving Sickness and Accident Benefits under the GM disability benefits plan. Following exhaustion of Sickness and Accident benefits in June 1989, plaintiff applied for and received Extended Disability Benefits beginning July 1, 1989. 2

Pursuant to the Supplemental Agreement’s provision regarding the IMO Program, defendant MetLife scheduled plaintiff to meet with Dr. James Beale on September 6, 1990 to render an opinion as to whether plaintiff was totally disabled. Dr. Beale conducted a physical examination of plaintiff and conducted several tests, including an EMG test. Dr. Beale issued a report dated September 19, 1990 wherein Dr. Beale found as follows:

PHYSICAL EXAMINATION:

* * * * * *
On examination he has tender scars over the volar aspects of both wrists, but they are healed. He has negative Tinel’s test, positive Phalen’s test on the right, positive forearm compression test on the right. All tests were negative on the left. Sensation was questionable over the median nerve.

CONCLUSION:

Based on this evaluation we ordered an EMG on September 12, 1990. The EMG showed no evidence of any neuropathy or carpal tunnel syndrome.
Based on this evaluation we feel that this patient is able to go back to work at this time with no restrictions.

Ex. J to Defendant’s Motion. Based on this report, defendant MetLife notified plaintiff *42 that his benefits would be terminated unless plaintiffs doctor submitted evidence to Dr. Beale which resulted in a change in Dr. Beale’s opinion. Plaintiffs doctor, Dr. Winkelman, thereafter submitted his finding that plaintiff could return to work only under certain restrictions. Dr. Beale reviewed Dr. Winkelman’s findings but refused to change his opinion as to plaintiffs condition. Plaintiff was then notified that his extended disability benefits were terminated as of September 13, 1990.

The GM Plan provides for a six-step administrative appeal procedure. The first three of those steps are as follows:

Step 1. Following receipt of the formal notification letter from Metropolitan by which the employe [sic] ... is advised of the reasons for the denial of his claim, the employe ... may request the representative whom his local union has designated to discuss [Plan] matters to review the reasons for the denial with the local management representative. .
Step 2. The local management representative will review the employe’s case with the local union benefit representative____ the local management representative ... will advise what, if anything, the employe ... can do to support the claim for payment of benefits....
Step 3. . If, after discussion with the local management representative, the local union benefit representative contests the poT sition of Metropolitan as reflected by the local management representative he may refer the case on an appeal form provided for that purpose to the International Union for review with the Corporation. A copy of such appeal form shall be presented to the local management representative.

Ex. B. to Defendant’s Motion at 94 (emphasis added). By letter dated February 8, 1993, 3 the local union benefit representative notified plaintiff that he, the union representative, had determined that there was no basis for appealing the IMO exam. Ex. 6 to Plaintiffs Response. Thus, plaintiff had gotten as far as the third step of the six-step appeal procedure when the procedure was terminated by the union representative’s discretionary decision to proceed no further.

On September 9,1993, plaintiff filed a complaint alleging violation of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq. Defendant brings the instant motion for summary judgment on two grounds. First, defendant claims that plaintiff has failed to exhaust his administrative remedies because he only proceeded as far as the third step of the appeal procedure outlined in the GM Plan. Second, defendant claims that the IMO report is final and binding on all concerned parties.

II. Analysis

As to defendant’s first claim, the court finds that plaintiff did indeed exhaust his administrative remedies. At the third step, the decision to appeal further is solely within the discretion of the union representative.

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Related

Hill v. Blue Cross and Blue Shield of Michigan
299 F. Supp. 2d 742 (E.D. Michigan, 2003)
Brooks v. General Motors Corp.
203 F. Supp. 2d 818 (E.D. Michigan, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
861 F. Supp. 40, 1994 U.S. Dist. LEXIS 12258, 1994 WL 456616, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mccoy-v-metropolitan-life-insurance-mied-1994.